| NPI | 1790768992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 33032) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200100615) |
| 208000000X Pediatrics (Licence: SC 33032) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-09-20 |